The impact of the 1993 Colombian health sector reform on the overall performance of the health system

Document Type



Master of Arts (MA)


Latin American and Caribbean Studies

First Advisor's Name

Eduardo A. Gamarra

First Advisor's Committee Title

Committee Chair

Second Advisor's Name

Carmelo Mesa-Lago

Third Advisor's Name

Lilly Langer

Date of Defense



The 1993 Colombian health reform act, known as Law 100, is an on-going process aimed at implementing substantive changes to universalize coverage and correcting well-documented deficiencies in the health sector. The purpose of this study is to assess to what extent the reform has achieved its goals in terms of four indicators: equity, efficiency, quality, and sustainability by means of implementing Pan American Health Organization's Methodology for Monitoring and Evaluation of Health Sector Reform in Latin America and the Caribbean.

This appraisal is a measure of the four indicators in two cross-sections of the population both before and after the reform. Data have been collected from primary and secondary sources including regulatory and steering agencies in Colombia. One of the main achievements of Colombian reform is the establishment of a subsidized system to cover the poorest segment of the population. The system's coverage in social security in health increased from 23% to 57% in the period 1993-1997. The public health insurance agency -the ISS- continues being the largest single insurer due in iv part to unfair competition strategies implemented by the ISS which in turn have increased the cost of health services in that agency. Finances of public hospitals still depend on national budget allocations made by the Ministry of Health. The productivity of human resources is low at all levels of the health system although hospitals have increased their funding from provision of healthcare services.

Several studies have documented problems of evasion and underreport of contributions that in the case of self-employees reach 92.6 percent, which threatens the sustainability of the system. In spite of having the highest freedom of choice in Latin America, the Colombian health system evidences low levels of technical quality and client satisfaction. Despite the increases in coverage and efficiency, assessment of quality and sustainability requires future research depending on the maturation of the system, and the concomitant development of data.



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